The predictable pharmacokinetic drug interaction between clozapine and rifampicin is listed in most standard reference texts but little detail is given or emphasis on its clinical significance. The interaction is based on theoretical knowledge of both drugs; to date just two case reports have been published. This article describes a third case demonstrating the significance of this interaction. This was potentially devastating for the patient who required an extended psychiatric admission. The enzyme induction was so potent that the dose of clozapine had to be increased approximately sixfold. Careful management of this significant interaction is essential for effective patient care.

The term Afro-Caribbean is used to describe black people of Caribbean origin in Britain. Migrants from the Caribbean, their children and their children's children are all covered by this term. The group as a whole is reported to have a higher incidence rate of schizophrenia than white groups, (King et al 1994), and British-born children of Caribbean parents have an even higher rate (Harrison et al, 1988). These reports have led to the hypothesis that Afro-Caribbeans may have a special vulnerability to schizophrenia. While limitations to these studies have been identified, (Wessly et al 1991) none has sought to question the use of the term Afro-Caribbean as a valid and reliable ethnic grouping. If we are to be able to produce good hypotheses for the aetiology of the reported increases in incidence, or to produce research which is useful to Black and ethnic minority groups, we need a clear understanding of the people under study.

Graduates in the UK are not choosing a career in psychiatry. This paper sets out to do three related things: review the factors that attract and deter medical students from a career in psychiatry, describe the provision of current summer schools and special programmes in psychiatry, and provide detail of how initiatives such as summer schools may be set up, run and evaluated locally to potentially address some of those issues identified in the first section.

This article highlights key findings from a recent Royal College of Psychiatrists project showing that many UK medical schools are embracing the dual challenge of raising students’ interest in psychiatry and ensuring that all doctors can support patients with mental illness. It focuses on two novel approaches to boosting recruitment into psychiatry: I'm a Medic Get Me Out of Here, an online outreach activity enabling schoolchildren to ask questions of health professionals in real time; and a living library, which creates a safe space for dialogue where topics are discussed openly between human books (professionals) and readers (undergraduate students) to challenge stereotypes. It is recommended that sharing these and other examples of good practice will help all medical schools encourage recruitment in psychiatry more widely.

The term ‘liaison psychiatry’ is becoming increasingly popular. Indeed, the Royal College of Psychiatrists has set up a special interest group, the Liaison Psychiatry Group, which has a growing membership. There appear to be developments in training and in service provision but it is difficult to assess their clinical impact. Ongoing research is required to quantify the actual level of service provided to general hospitals.

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

Service development is guided by outcome measures that inform service commissioners and providers. Those in liaison psychiatry should be encouraged to develop a positive approach that integrates the collection of outcome measures into everyday clinical practice. The Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) is a very useful tool to measure service quality and clinical effectiveness, using a combination of clinician-rated and patient-rated outcome measures and patient-rated experience measures. However, it does not include measures of cost-effectiveness or training activities. The FROM-LP is a significant step towards developing nationally unified outcome measures.

Recent ministerial statements and health circulars have identified a key role for the NHS in providing services for people with a learning disability who have a mental illness or a severe behaviour disorder (NHS Management Executive, 1992). This is not an insignificant task, given that psychiatric disorders (including both mental illness and/or severe behaviour disorders) occur among approximately 30% of people with a moderate or severe learning disability (Corbett, 1979; Lund, 1985). Patients with psychiatric disorders have proved particularly difficult to resettle from mental handicap hospitals, and form a substantial proportion of the patients who become long-stay residents of mental handicap hospitals despite the development of community-based services. It is therefore essential that each district health authority defines the most appropriate pattern of services for this group of patients, as part of their purchasing strategy for mental health. The type of service required was discussed by the department of Health report Needs and Responses: Services for Adults with Mental Handicap who are Mentally Ill, who have Behaviour Problems, or who Offend. This noted that no consistent pattern of services has yet emerged, and that suitable alternatives included admission to a specialised mental illness unit in a mental handicap hospital, admission to a general psychiatric ward, admission to a small staffed house, or treatment by a community support team.

A recent Royal College of Physicians' study on assessment raises serious questions for workplace assessment. To address these, a system is recommended that bridges the gap from competence to performance and integrates supervised learning events (SLEs) that are formative in purpose with summative assessment of performance by entrustable professional activities (EPAs).

Workplace-based assessment is a core element of the changes introduced in Modernising Medical Careers (MMC), yet it has been sparsely researched in the UK and there are still psychometric and validity data needed to support its introduction. Supervisors and tutors are wary of it, but it could replace external clinical examinations leading to a Certificate of Completion of Training. The theoretical background of assessment in the workplace is ‘Miller's pyramid’ of competence in which the trainee progresses from ‘knowing’ (tested by paper exam), through ‘knows how’, to ‘shows how’ (tested by the Observed Standardised Clinical Examination), and finally ‘does’ (assessed in the workplace) (Miller, 1990).